4/21/2023 EnchantaVaughn Approved (AM) Upon arrival, client was in a loving spirit and appeared to be happy to be in school. Client grabbed breakfast and walked to class to prepare for morning activity. Client displayed functioning and on task behaviors, indicating he was going to have a good day. Client was witnessed in class being productive and positive towards his peers and teachers, saying hello and smiling at them. Client started off his morning displaying responsible behaviors by knowing what to do without having the teacher direct him through each activity. Client maintained productive and collaborative behaviors going into social activities. Client have been doing an amazing job following rules and being respectful. Client understands his expectations and promises to stay calm so that he won’t be involved with any incidents that could lead him into trouble. Client tend to get off track when trying to be involved with situations outside of his own but has been working on that. Client exhibited good sportsmanship during team building activity, as reported by teacher. Client continues to ignore distractions, as seen when he avoids peer pressure and following behind others who are doing wrong. Client has attempted to maintain expectations within the classroom when unsupervised, but as soon as the teacher left the room he started acting out and presenting silly behavior. Client displayed poor listening skills. Client went to lunch without hyperactive behaviors and appeared more calm and relaxed during this time. (PM) Client failed to transition to session area, displaying inappropriate behaviors and being careless. could not wait for instruction without moving around and talking out of turn. Client expresses good statements about turning his day around, using his manners, and processing his thoughts and feelings. Client is less confident in group setting, as evidenced by him shutting down when he felt he couldn't relate to the others. Client still struggle with controlling impulsive and hyperactive behaviors, due to fidgety and restless behavior. Client increased sadness make it hard for him to understand his disorder. Client seem more aggrivated and less content with himself, due to losing points and not getting a treat. Client growth and development have declined since the beginning of the school year and additional support was offered by TDT staff. (EOD) Client returned to academic setting in a civil manner and went to his seat to try and finish his work. Client was seen working independently and staying to himself. Client was put at a desk next to the teacher as an alternate calming area and this have been increasing good behavior, as well as, pushing him to concentrate and focus on his work. Client communicates negative feelings about school and wanting to get away from everybody. Client stated he could't help his wrongful actions, demonstrating he was not aware of his mistakes. Client dismissed from school in a frustrated mood, indiciating he did not achieve objectives 1, 2, and 3. (AM) QMHP observed client while in the classroom in efforts to determine the need for intervention. QMHP was informed of the clients behaviors. QMHP reviewed the reported behaviors with client in efforts to allow him to express his point of view. QMHP encouraged client to list alternative behaviors he could have participated in. QMHP provided a positive hand gesture such as a thumbs up in efforts to show approval of clients current actions. QMHP did not have to redirect client. QMHP will continue to assist client with managing anger and frustration by reviewing and modeling effective coping skills. QMHP processed and explained the process and importance of coping skills. QMHP prompted client to identify one coping strategy he uses when he becomes upset or frustrated. QMHP processed and explained the effects of positive coping mechanisms with client. (PM) QMHP observed client as he walked through the hallways with his classroom being led by his teachers. QMHP stated simple praises to client as he walked past. QMHP will continue to offer postive reinforcement when observing client adhering to his ISP objectives. QMHP observed client in his classroom in efforts to assist with any negative behaviors towards his classmates or his teachers. QMHP did not have to intervene with clients behaviors as he demonstrated adherance to classroom rules and expectations. QMHP encouraged the client to respect his teacher. QMHP reviewed school rules and expectations with client before walking him into his seat, ensuring that he was safe and comfortable. (EOD) QMHP informed client that he has been showing a lot of improvement in efforts to support his accomplishment. QMHP provided strategies such as positive reframing. QMHP assisted client with practicing reframing negative thoughts with more positive thoughts in efforts to reduce impulsive reactions throughout the day. QMHP implemented positive mantras with client, reminding him to process his ISP objectives. QMHP thoroughly explained negative consequences for negative behaviors. QMHP reviewed expectations while transitioning with client to evening specials. QMHP prompted the client to be mindful of his behaviors and how they affect others. QMHP supported client with packing and putting away his supplies. QMHP was informed that client dismissed without incident by his teachers. (AM) Client transitions smoothly and safely to session area, displaying appropriate behaviors. Client smiled as he saw QMHP's positive gestures. Client greets his group members and waits for instruction. Client expresses good statements about his day saying he was doing his work, using his manners, and being fair to others. Client is more confident at school, as evidenced by assertive and proud tone. Client have been doing a better job controlling impulsive and hyperactive behaviors, due to keeping his hands to himself and staying in designated area. Client reduces sadness and finds more excitement in learning about the events associated with bringing awareness to the less unfortunate and at-risk children. (PM) Client displayed appropriate transition in the hallways. Client displayed excellent rapport in therapy session, as evidenced by his positive attitude and willingness to contribute to discussion. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. Client reduced impulsive behaviors after 3-4 prompts from his teachers and QMHP. Client began to show greater control of his anger. Client appeared to decrease the intensity of his anger and frustration. Client was able to reduce negative behaviors and focus on the lesson. (EOD) Client was observed and reported to have been pleasant and cooperative during classroom activities and demonstrated a willingness to adhere to school and classroom rules and expectations. Client listed 3-4 classroom behaviors that he was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to recieving positive reinforcement from his teacher as demonstrated by his smiling and inviting body language. The client said thank you. The frequency and intensity of the client's defiant affect decreased. Client utilized positive body language as he interacted with his group, taking turns demonstrating each prompt and reflecting on his experience and choices. Client was reported to have dismissed without incident.